Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) act by increasing the concentration of serotonin available to nerve cells. Currently the most prescribed antidepressants in the world, this group includes of citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. The SSRIs are safer and better tolerated than MAOIs and TCAs. There is still some lingering controversy as to whether they are as potent as the older antidepressants for very severe depression. The SSRIs are generally not lethal in overdose, which is a significant benefit in the elderly depressed patients who are at the highest risk for suicide. The common side effects of SSRIs include nausea, vomiting, diarrhea, headaches, anxiety, sexual problems, and sleeplessness. Usually the side effects are temporary in nature. In elderly people, fluoxetine has been reported to cause some weight loss, agitation, and also stays in the body for a long time. Also, it should be noted that fluvoxamine is not approved by the FDA (Food and Drug Administration) for the treatment of depression. Medications in this group are also known to interact with other drugs often causing a reduced metabolic breakdown. Of the available SSRIs, citalopram and sertraline have relatively lesser drug interactions and are well tolerated in older people. These medications are also associated with some unusual side effects predominantly in elderly people. One such side effect is the decrease in sodium in the blood (hyponatremia). The other is the report of higher incidence of Parkinson's disease—like movement problems in elderly people. There have been some recent reports of falls in elderly patients even with the use of SSRIs (which were previously thought not to increase the risk of falls in the elderly when compared to TCAs).